Re: James Gushue
ORB File No: 5298
Hearing held on: Monday, March 30, 2026
Place of hearing: Waypoint Centre for Mental Health Care
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. S. Clapp Members: Dr. P. Darby Dr. A. Gibas Ms. C. Murray Ms. B. Little
Parties Appearing:
Accused: James Gushue Counsel: Mr. A. McIver Person in Charge of Hospital: Representative: Ms. T. Murdock Attorney General of Ontario: Counsel: Ms. S. Curry
REASONS FOR DISPOSITION
(Dated April 14, 2026)
Introduction:
On March 10, 2009, James Gushue was found not criminally responsible on account of mental disorder (“NCR”) on a charge of attempt murder, contrary to the Criminal Code of Canada (“Criminal Code”). Mr. Gushue is currently subject to a Disposition of the Ontario Review Board (the “Board” or “ORB”) dated April 16, 2025, detaining him at the High Secure Provincial Forensic Programs at the Waypoint Centre for Mental Health Care (“Waypoint” or the “hospital”), with privileges up to and including hospital grounds privileges beyond the secure permitter escorted by staff. Mr. Gushue is also required to abstain from substances and refrain from possessing any weapons.
On March 30, 2026, a panel of the Board convened at Waypoint to review Mr. Gushue’s Disposition pursuant to s. 672.81(1) of the Criminal Code. Mr. Gushue was present for his hearing and was represented by counsel, Mr. A. McIver.
The Hospital Report dated February 18, 2026, was marked as Exhibit 1. A Rule 13 Transfer request to the Ontario Shores Centre for Mental Health Sciences (“Ontario Shores”) dated February 6, 2026, was marked as Exhibit 2; and the response from Ontario Shores dated March 17, 2026, was marked as Exhibit 3. In addition to the documentary evidence, Mr. Gushue’s attending psychiatrist, Dr. P. Ismail, gave evidence.
The issues to be decided at the hearing were whether Mr. Gushue continues to represent a significant threat to the safety of the public as set out in section 672.5401 of the Criminal Code, and, if so, what is the necessary and appropriate disposition to manage that risk having regard to the criteria set out in s. 672.54 of the Criminal Code.
Positions of the Parties:
At the outset of the hearing, the parties were asked for their initial without prejudice positions. On behalf of the hospital, Ms. Murdock took the position that Mr. Gushue remains a significant threat to the safety of the public, and that a continuation of the existing Detention Order was necessary and appropriate.
Ms. Curry supported the position of the hospital on behalf of the Attorney General.
Mr. McIver did not dispute the issue of significant threat but stated that Mr. Gushue wants more privileges than he is currently allowed. Mr. McIver also advised that after reviewing the response from Ontario Shores, Mr. Gushue was not pursuing a transfer at this time.
Findings:
- For the reasons set out below, the panel found that Mr. Gushue continues to pose a significant threat to public safety. The panel concluded that the necessary and appropriate Disposition, which is also the least onerous and least restrictive in the circumstances, is a continuation of the existing Detention Order.
Index Offence:
- The circumstances of the index offence are excerpted from last year’s Reasons for Disposition as follows:
“On September 2, 2008, Mr. Gushue was living with his two uncles, when he spontaneously got a paring knife from the kitchen, approached one of his uncles and, using the knife, stabbed and cut him. His other uncle intervened and together they managed to get the knife away from Mr. Gushue and subdue him until the police arrived.”
Background:
The Hospital Report outlines Mr. Gushue’s background in detail and need not be repeated here. In summary, Mr. Gushue is a 38 year old single man who has one sister and one brother. His childhood was described as unremarkable. He used drugs and alcohol from a young age and began experiencing symptoms of his mental illness around the age of 18.
Mr. Gushue had difficulties in school and was asked to leave in grade 11. Mr. Gushue does not have any employment or relationship history. He lived with his parents and then with his uncles, where the index offence occurred.
Criminal History:
- The Hospital Report outlined Mr. Gushue’s criminal offence history (at pages 3-4) which included multiple convictions between 2004 and 2008 for failing to comply with undertakings, as well as theft and assaults.
Psychiatric History:
The Hospital Report outlined Mr. Gushue’s psychiatric history both prior to the index offence and following it. In summary, Mr. Gushue had a number of hospitalizations between 2005 and 2007 as a result of assaults against family members. He was diagnosed with Schizophrenia. Following this, Ms. Gushue had multiple admissions related to assessments of fitness and criminal responsibility for criminal offences. During this time, he assaulted a co-patient, regularly banged his head, and was noncompliant with medication. He was connected to the Peterborough Assertive Community Treatment (“ACT”) Team for community follow-up.
Following the index offence, Mr. Gushue was detained at the Mental Health Centre Penetanguishene, Oak Ridge Division (“Oak Ridge” (now Waypoint)). Following a Treatment Order, he was found fit to stand trial and was then found NCR. While at Oak Ridge, Mr. Gushue was found incapable of consenting to treatment, and his mother was his substitute decision-maker. Mr. Gushue was described as grossly psychotic and unwell despite being treated with two antipsychotic medications. Clozapine was started, and he improved to the point where a recommendation was made to transfer him to a medium secure facility.
Mr. Gushue was transferred to Ontario Shores in April 2009. He continued to do well, had improved insight, and used indirectly supervised passes into the community. He was found capable of consenting to treatment in 2010 and obtained employment. Mr. Gushue was discharged to the community in February 2011 and was followed by an ACT team three times per week.
Mr. Gushue was admitted to hospital in November 2012 and was described as floridly psychotic. There had been issues with Mr. Gushue’s adherence to Clozapine in the community and it was determined that he required more supportive housing. Mr. Gushue improved with resumption of treatment with Clozapine, and he was discharged to a 24-hour supervised group home with ACT team support in December 2013. Mr. Gushue moved again in October 2014 (smaller group home) and then in December 2014 (his name came up on a waitlist). It was noted that Mr. Gushue’s symptoms had been in remission since January 2013 and there had been no positive drug screens since 2012. Mr. Gushue was granted a Conditional Discharge in 2014.
Unfortunately, a significant and unexpected decompensation followed, and Mr. Gushue was readmitted to hospital in November 2015. The brittle nature of his mental illness was cited. Different medications were trialed with no improvements. Mr. Gushue required transfer to a secure unit and was found incapable of consenting to treatment in May 2016. There were numerous AWOL attempts and aggressive episodes. A Detention Order was reinstated with no community living privilege.
An early Board hearing was requested by Ontario Shores as a result of Mr. Gushue’s multiple AWOL attempts and a therapeutic impasse. Mr. Gushue was transferred back to Waypoint in March 2019. Since returning to Waypoint, Mr. Gushue has been difficult to manage despite general compliance with medication. There were unprovoked assaults and threats, self-injurious and bizarre behaviours, as well as sexually inappropriate behaviours. Seclusion was required on many occasions. In 2021, Mr. Gushue was secluded for over nine months after he punched a staff member and a co-patient in the face.
Electroconvulsive therapy (“ECT”) was commenced in April 2021 and Mr. Gushue showed improvement in his mental state. However, Mr. Gushue continued to experience fluctuations in his symptoms, including unprovoked assaults and other behaviours requiring seclusion.
The Hospital Report lists Mr. Gushue’s diagnoses as: Treatment Resistant Schizophrenia; Antisocial Personality Disorder; Polysubstance Use Disorder (Alcohol, Cannabis, Cocaine) in sustained remission in a controlled environment; and Intellectual Disability, Mild. Mr. Gushue is incapable of consenting to treatment, and his mother is his substitute decision-maker.
Evidence at the Hearing:
The Hospital Report stated that Mr. Gushue is treated with three antipsychotic medications (including Clozapine) as well as ECT once per week. Mr. Gushue missed several doses of Clozapine in August 2025, so it was discontinued; however, it was restarted in October 2025.
The Hospital Report stated that Mr. Gushue’s mental status fluctuated over the review period. At the outset, he presented with a dysphoric and flat affect, with limited reactivity. He was described as quite psychotic, with command auditory hallucinations and disorganization to the point where he was undressing and covering himself with feces. There were also times where Mr. Gushue was self-injurious, intentionally slamming/hitting his head into his door and/or ripping off his fingernails.
Seclusion was required to manage Mr. Gushue’s risk three times over the course of the review period as a result of verbal aggression and numerous instances of physically aggressive behaviour where Mr. Gushue attempted to or assaulted staff and/or co-patients. Restriction of Liberty hearings occurred on May 7, 2025, and August 12, 2025, and the Board concluded that the decisions to significantly increase the restrictions on Mr. Gushue’s liberties were warranted.
The Hospital Report stated that, more recently, Mr. Gushue’s affect has improved. He has been more engaged and is able to articulate his needs. While he continues to experience perceptual disturbances, he has not presented with maladaptive or aggressive behaviour, has been appropriate on-unit with increased attendance in groups of interest to him, and has participated in off-unit activities.
A Psychological Assessment completed in May 2023 concluded that Mr. Gushue’s intellectual functioning indicates an “extremely low functioning profile.”
Dr. Ismail’s Clinical and Composite Assessment of Risk dated February 18, 2026, included the following paragraphs (at page 144-146 of the Hospital Report):
“Mr. Gushue continues to represent a significant risk to the safety of the public. Although there has been observable improvement in behavioural stability since late October 2025, the overall course of the review period is marked by severe psychotic decompensation, unpredictable and unprovoked violence, impaired insight, treatment noncompliance, and the need for prolonged seclusion and restraint to mitigate risk. The totality of the evidence supports continuation of the current high secure disposition.
Although Mr. Gushue has recently maintained a C5 security level, participated in on-unit programming, completed two escorted non-secure walks without incident, and engaged in vocational programming, these gains have occurred within a highly structured, high secure forensic environment with intensive monitoring, rapid access to PRNs, and graduated privileges. His stability is recent relative to the severity and duration of prior instability and has been achieved under maximal containment conditions. His history demonstrates that decompensation can occur abruptly and without clear provocation, even during periods of apparent stability.”
Dr. Ismail testified that Mr. Gushue’s Schizophrenia is “ultra-treatment resistant.” Multiple consultations with the Medication Assessment Program for Schizophrenia (MAPS) have been done over the years to try and assist with finding medications that may be effective for Mr. Gushue. The most recent MAPS consultation (February 7, 2025) recommended optimization of ECT and Clozapine, and stopping an anti-seizure medication. Recently, Paliperidone (at the highest dose) was introduced, and this has had a stabilizing effect along with Clozapine and ECT. Dr. Ismail also testified that Mr. Gushue is quite sensitive to the side effects of Clozapine, so any increase in dose needs to be done slowly and monitored carefully.
Dr. Ismail stated that the Awenda program is very appropriate for Mr. Gushue as it is geared toward people with intellectual disabilities. He was of the opinion that Mr. Gushue would have less quality of life at a less secure facility and his risk of physical aggression and resultant seclusion incidences would increase.
Dr. Ismail testified that Mr. Gushue currently has the highest privilege level that is offered in the high secure setting, and there is not more that could be offered. This enables Mr. Gushue to be off the unit for up to four hours at a time unsupervised, and he can use the privilege more than once per day. He can access the gym and pool area, the canteen, and vocational training. Mr. Gushue runs the Pit Stop store in the canteen and has done a good job. Mr. Gushue is also allowed to go out for escorted walks on the hospital property, which he has done multiple times since November 2025.
In response to questions, Dr. Ismail acknowledged that Mr. Gushue has made significant progress since November 2025, including with respect to his aggressive behaviours, mood, overt psychotic symptoms, violent ideation, and cognitive and executive functioning. He has also shown improvement in his insight into his mental illness, his violence risk, and his need for treatment. It was Dr. Ismail’s opinion that the additive effect of ECT is what has changed Mr. Gushue’s symptoms in the most meaningful way. Dr. Ismail was satisfied with the frequency of ECT once per week at the current time, as Mr. Gushue is now improving.
Dr. Ismail testified that Mr. Gushue will require a group home geared toward people with Schizophrenia and Intellectual Disability, with sufficient support for medication administration and maintenance ECT. An appropriate home has not yet been identified. Mr. Gushue is not able to live with family.
Dr. Ismail stated that the plan for the coming year is to continue to monitor Mr. Gushue’s response to medications, monitor for any side effects and adjust the treatment, if necessary, encourage Mr. Gushue to participate in more programs on the ward (including Cognitive Behavioural Therapy (CBT) and Dialectical Behaviour Therapy (DBT)), and to emphasize the idea that ECT is very important for his ongoing stability.
Dr. Ismail anticipated that there will come a time when Mr. Gushue will be able to be safely managed in a less secure facility; however, he noted that more long-term stability is required in light of Mr. Gushue’s history where he has shown periods of short-term stability followed by relapse.
Dr. Ismail was not sure whether Mr. Gushue was receiving Disability Services Ontario (DSO) funding and agreed to follow-up.
In response to questions from Mr. McIver, Dr. Ismail stated that there are not sufficient resources currently to take the patients in the high secure forensic programs into town.
No further evidence was called by the parties.
Submissions:
Ms. Murdock and Ms. Curry maintained their positions on behalf of the hospital and the Attorney General that Mr. Gushue remains a significant threat to the safety of the public, and that a continuation of the existing Detention Order is necessary and appropriate. While Mr. Gushue has made notable improvements in recent months, he requires a longer period of stability in the specialized Awenda unit before a transfer to a less secure facility, where more community privileges are available.
Mr. McIver agreed that a Detention Order is the least onerous and least restrictive Disposition for Mr. Gushue at the current time. However, he noted Mr. Gushue’s improvements since November 2025 and submitted that the hospital and the Board need to provide Mr. Gushue with incentive for his continued improvement beyond the “strict status quo” privileges.
Analysis and Conclusions:
Based on the Hospital Report and the evidence of Dr. Ismail, the panel concluded that Mr. Gushue continues to represent a significant threat to the safety of the public. Mr. Gushue has had a long and varied course under the Board, with periods of significant violence and aggression (which required prolonged seclusion), medication noncompliance, and impaired insight. Although Mr. Gushue has shown improvement in a number of domains, this is a very recent development. The panel noted that Mr. Gushue’s mental illness is described as “brittle” and “ultra-treatment resistant” and that he is incapable of consenting to treatment. The panel accepted Dr. Ismail’s testimony and his clinical assessment of risk and concluded that absent the oversight of the forensic system, Mr. Gushue is at high risk to discontinue medications and act out in a similar way to the index offence.
The panel found that a continuation of the existing Detention Order was necessary and appropriate, and the least onerous and least restrictive Disposition for Mr. Gushue at this time. The panel noted that Mr. Gushue’s recent gains have occurred within the highly structured and specialized Awenda unit with intensive monitoring and supports. The panel specifically relied on the evidence that Mr. Gushue’s stability is recent and short-lived relative to the severity and duration of prior instability, and that his history demonstrates that decompensation can occur abruptly and without clear provocation, even during periods of apparent stability. Like Dr. Ismail, the panel is hopeful that Mr. Gushue’s improvements will continue and that he will be ready for transfer to a less secure facility (with increased privilege opportunities) in the future. The panel noted that Ontario Shores stated in their letter of March 17, 2026, that Mr. Gushue may be a suitable candidate for transfer in 2027 if he maintains and improves upon his gains.
The panel accepted Dr. Ismail’s evidence that Mr. Gushue currently has the highest privilege level that is allowed in the High Secure Provincial Forensic Programs. He has only been utilizing this highest level since November 2025, which is not an extended period of time. While it would be ideal for the treatment team to be able to give Mr. Gushue “more than that”, or individual treatment given his recent gains, based on Dr. Ismail’s evidence and the general knowledge of the panel, this is not realistic based on constraints around current resources and staffing at Waypoint. Mr. Gushue is encouraged to continue to consistently utilize his privileges in an appropriate way, and to spend more time on the ward engaging in therapeutic programming in order to assist him with maintaining his current positive trajectory.
DATED this 14th day of April 2026, at the City of Toronto, in the Toronto Region.
Ms. S. Clapp Alternate Chairperson
Office of the Registrar Ontario Review Board